NESS - Theoretical Framework for Assessing Emergency and Essential Surgical Care Within Primary Health Care Systems

Theoretical Framework for Assessing Emergency and Essential Surgical Care Within Primary Health Care Systems
*Peter Bendix¹, *Americo Assane², *Fernando Vaz³, *David Spiegel⁴, *Richard Gosselin⁵, *Fizan Abdullah⁶, *Raymond Price⁷, *Doruk Ozgediz⁸, *Jamie Anderson⁹, *David Chang¹⁰, *Emilia Noormahomed¹¹, *Stephen Bickler¹⁰
¹Dartmouth-Hitchcock Medical Center, Lebanon, NH;²Ministry of Health - Mozambique, Maputo, Mozambique³ISCISA, Maputo, Mozambique⁴University of Pennsylvania, Philadelphia, PA;⁵UC Berkeley School of Public Health, Berkeley, CA;⁶The Johns Hopkins Hospital, Baltimore, MD;⁷Intermountain Health Care, Salt Lake City, UT;⁸Women and Children's Hospital of Buffalo, Buffalo, NY;⁹UCSD School of Medicine, San Diego, CA;¹⁰UCSD Medical Center, San Diego, CA;¹¹Universidade Eduardo Mondlane, Maputo, Mozambique

Background: The 2008 World Health Report identifies emergency and essential surgical care (EESC) as a central component of primary health care (PHC). Inherent in this evolving paradigm is the need to develop tools for monitoring and evaluating surgical care within PHC systems. The World Health Organization (WHO) Monitoring the Building Blocks of Health Systems Monitoring and Evaluation Matrix (MBBHS M&E Matrix) provides a comprehensive strategy for assessing PHC systems but has not been adapted to monitor and evaluate surgical care.
Methods: Five WHO documents relating to EESC were reviewed to identify surgical metrics for integration into the WHO MBBHS M&E Matrix. For MBBHS M&E Maxtrix domains lacking surgical indicators, new metrics are proposed based upon the literature and our experience with EESC in low and middle-income countries.
Findings: 10 of 15 (66%) MBBHS M&E Matrix indicator domains were represented by surgical metrics found in WHO EESC documents. Individual EESC documents averaged six of 15 (40%) of the MBBHS domains. The indicator domains of "Inputs and Processes", "Outputs" and "Outcomes" were partially represented within each EESC source, but often with redundancy. Surgical metrics for the "Impact" domain were not found in any WHO documents. We offer refinement of surgical indicators in domains that have duplications and propose surgical metrics for missing categories.
Conclusions:The MBBHS M&E matrix provides a new strategy for assessing surgical care within PHC systems. This is more comprehensive than previously used. It could elucidate changes required to improve surgical care in low- and middle-income countries. Use of these indicators should allow policy makers, funders, researchers, and NGOs to advance surgical care in PHC systems. All indicators require validation through expert review and field-testing.

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